Nursing homes, already facing difficulties in recruiting staff, are now contending with President Donald Trump’s crackdown on one of their few dependable sources of labor: immigration.
Facilities serving older adults and people with disabilities are experiencing intermittent staff losses as employees lose their legal status under Trump’s policies. However, they worry that even more severe consequences lie ahead, as the flow of potential workers dwindles amid a broader decline in legal immigration.
“We feel completely beat up right now,” says Deke Cateau, CEO of A.G. Rhodes, which operates three nursing homes in the Atlanta area, with one-third of the staff made up of foreign-born people from about three dozen countries. “The pipeline is getting smaller and smaller.”
Eight of Cateau’s employees are anticipated to be forced to leave following the revocation of their Temporary Protected Status (TPS). TPS permits individuals already residing in the U.S. to remain and work legally when their home countries face dangers such as civil unrest or natural disasters. Under the Biden administration, this designation was broadened to include people from a dozen countries, notably large populations from Venezuela and Haiti.
Although employees with TPS make up only a small fraction of A.G. Rhodes’ 500 staff members, Cateau emphasizes they will be “very difficult, if not impossible, to replace,” and he remains concerned about what the future holds.
“It may be eight today, but who knows what it’s going to be down the road,” says Cateau, an immigrant himself, who arrived from Trinidad and Tobago 25 years ago.
According to the Bureau of Labor Statistics, nearly one in five civilian workers in the U.S. is foreign-born. Similar to sectors like construction, agriculture, and manufacturing, immigrants are disproportionately represented in caregiving roles. PHI, a nonprofit organization dedicated to the caregiving workforce, reports that over a quarter of the estimated 4 million nursing assistants, home health aides, personal care aides, and other direct care workers are foreign-born.
The aging of the large Baby Boomer generation is expected to drive a significant increase in demand for caregivers, both in healthcare facilities and private homes. The Bureau of Labor Statistics projects that home health and personal care aide roles will experience the fastest growth of any occupation, with approximately 820,000 new jobs anticipated by 2032.
Nursing homes, assisted living facilities, home health agencies, and similar providers have long relied on immigrants to fill many of these essential roles. Consequently, Trump’s return to the White House and his administration’s crackdown on nearly all forms of immigration has cast a deep chill across the industry.
Katie Smith Sloan, CEO of LeadingAge, an organization representing nonprofit care facilities, says that homes across the country have been impacted by the immigration upheaval. Some report employees who, despite having legal status, have stopped coming to work out of fear of raids. Others have staff staying home to care for children kept out of school due to concerns about immigration roundups. Additionally, many facilities are experiencing a noticeable decline in job applicants.
“This is just like a punch in the gut,” she says.
Rachel Blumberg, CEO of the Toby and Leon Cooperman Sinai Residences in Boca Raton, Florida, has already lost 10 employees whose legal stay in the U.S. was granted under the humanitarian parole program, which applied to individuals from Cuba, Haiti, Nicaragua, and Venezuela. She expects to lose an additional 30 workers in the coming weeks following the termination of Temporary Protected Status (TPS) for Haitians.
“I think it’s the tip of the iceberg,” says Blumberg, predicting more employee departures—not necessarily due to their own deportation, but because their spouse or parent may be affected.
Blumberg received less than 24 hours' notice before her employees lost their work authorization, triggering a frantic effort to cover shifts. She has already increased salaries and referral bonuses but acknowledges that replacing not only aides, but also maintenance workers, dishwashers, and servers will be a significant challenge.
“Unfortunately, Americans are not drawn to applying and working in the positions that we have available,” she says.
According to PHI, front-line caregivers are predominantly female, with most belonging to minority groups, and earned an average hourly wage of just $16.72 in 2023.
Long-term care homes experienced a significant workforce exodus as COVID-19 exacerbated an already challenging work environment. While some facilities were starting to return to pre-pandemic staffing levels just as the immigration crackdown began, the industry as a whole continues to face a severe labor shortage.
Some industry members have watched with frustration as Trump expressed concern over how his policies might harm sectors like farming and hospitality, questioning why workers who clean hotel rooms or pick tomatoes seem to receive more attention than those caring for the elderly. Beyond the revocation of work authorizations for residents in the U.S., care homes are also struggling to secure visa approvals for registered nurses and licensed practical nurses they recruit from abroad.
What was once a straightforward process has now become so prolonged that candidates are reconsidering their decision to come to the U.S., says Mark Sanchez, chief operating officer of United Hebrew, a nursing home in New Rochelle, New York.
“There are lines upon lines upon lines,” says Sanchez, “and now they’re saying, ‘I’m going to go to Canada’ and ‘I’m going to go to Germany and they’re welcoming me with open arms.'”
Surveying a facility staffed predominantly by immigrants, the son of Filipino immigrants questions where his future recruits will come from.
“I don’t have ICE coming in my door and taking my people,” Sanchez says, “but the pipeline that was flowing before is now coming in dribs and drabs.”
Long-term care workers are frequently drawn away not only by hospitals and medical offices but also by restaurants, retail stores, and factories. Federal data shows that, on average, half of a nursing home’s staff turns over annually, making the recruitment and retention of every employee crucial to their operation.
Robin Wolzenburg of LeadingAge Wisconsin began facilitating the placement of Afghan refugees after the U.S. withdrew its final troops four years ago, leading to thousands of refugees arriving in her state. Care homes started hiring these refugees and were so impressed with their performance that some facilities extended hiring to refugees from Ukraine, Somalia, and Congo. While many homes typically have employee retention rates around 30%, Wolzenburg noted that retention among refugees exceeded 90%.
Trump’s suspension of most refugee admissions means Wolzenburg’s successful outreach program now has no new arrivals to support.
“It’s been really devastating,” Wolzenburg says. “Our communities that were actively working with the resettlement agencies are not seeing those referrals to long-term care like we were. There’s no refugees coming in.”
Lynne Katman, founder of Juniper Communities—which operates 21 facilities across five states—says finding workers truly passionate about caring for older adults is already a challenge. Now, as care homes prepare for an influx of residents driven by the nation’s demographic shift, they face yet another obstacle to maintaining a stable workforce.
“The work is hard. It’s not always been the highest paying job that one can get,” she says. “But many of the immigrants who actually have chosen this work consider caregiving a noble profession.”
Photo: Dining room staff listen to instructions from their manager just before the start of an Independence Day buffet service, in the independent living community at the Toby and Leon Cooperman Sinai Residences, July 4, 2025, in Boca Raton, Fla. (AP Photo/Rebecca Blackwell)
